Active implantable medical devices, hereafter simply called “implants”, typically have a data memory to store information that can be read by use of an external programmer employing telemetry techniques that are in themselves well-known. The external programmer (or more commonly, the “programmer”) is associated with a microcomputer at the disposal of the physician and includes a display screen, a telemetry head for communicating with an implant, a keyboard and mouse (or other user interface) for the input of control parameters and the data, as well as various circuits for memorizing and processing of data (e.g., data acquired by the implant).
The physician, who is a user of the programmer, is a specialized doctor with access to information, namely the patient data and the operating parameters, that is stored in the memory of the implant. This include information consists of, among other things the various “programming” controls, including, for example, the controls to modify the setting parameters, and, thus, the operation of the pacemaker.
The starting point of the present invention is the observation that, very often, the physician-user of the programmer needs to question an expert, for example, to be able to choose the most suitable adjustments for the programmer and/or the implant. This need is even more important with the most advanced devices that have a wide variety of adjustments and are not always easy to choose and to parameterize in a way most appropriate for each patient.
To satisfy this particular need, it is known, for example, from EP-A-0 856 333 (assigned to Ela Medical SpA) how to implement a connection between the station where the physician sits and the distant site where the expert is, with several lines, including:                a first line for the transmission of the parameters from the pacemaker towards the distant site,        a second line for the establishment of a bidirectional voice communication between the physician and the expert, and        a third line for the possible transmission, in real time, of a surface electrocardiogram. Experience has indeed shown that a voice connection is absolutely essential for effective remote support because data transmission on its own, even when accompanied by messages in the form of short text, is insufficient to obtain satisfactory help. Such help generally requires a total interactivity between the physician's observations and handling of the advice, and the advice given by the expert providing remote support.        
One of the problems with this solution, however, is that in practice this proposal requires two, or even three, distinct telephone links, and thus is difficult to implement in a hospital environment. Indeed, in general, electrophysiology rooms currently have only one telephone line, which would require either equipping each particular room with a second line, an expensive proposition, or making the connection using a second line located in another room, which, of course, is inconvenient.
Because of the constraints found in the hospital environment, it is not possible to use for the voice connection a wireless or mobile (cell) telephone. The use of these apparatuses is prohibited in hospitals because of the risks of disturbing the surrounding equipment with the powerful electromagnetic signals produced by these telephones.